MEDICARE: EMILY T COLLINS BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst	1-22-57819	OK

General Provider Information

NPI Number	:	1619532926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY T COLLINS BCBA

Provider Business Mailing Address
First Line	:	25 N RIVER LN STE 2109
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-2003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13905 TECHNOLOGY DR # A1
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1054
Country	:	US
Telephone Number	:	405-389-4530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2019
Last Update Date	:	05/01/2023

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